Asynchronous Remote Medical Consultation for Ghana

Computer-mediated communication systems can be used to bridge the gap between doctors in underserved regions with local shortages of medical expertise and medical specialists worldwide. To this end, we describe the design of a prototype remote consultation system intended to provide the social, institutional and infrastructural context for sustained, self-organizing growth of a globally-distributed Ghanaian medical community. The design is grounded in an iterative design process that included two rounds of extended design fieldwork throughout Ghana and draws on three key design principles (social networks as a framework on which to build incentives within a self-organizing network; optional and incremental integration with existing referral mechanisms; and a weakly-connected, distributed architecture that allows for a highly interactive, responsive system despite failures in connectivity). We discuss initial experiences from an ongoing trial deployment in southern Ghana.Comment: 10 page

National remote and regional transport strategy: consultation draft

On 22 May 2014, the Northern Territory hosted the National Remote and Regional Transport Infrastructure and Services Forum in Alice Springs, attended by 120 industry, government and community representatives from all areas of Australia. Following the Forum, the Council agreed for the Northern Territory to lead the development of the National Remote and Regional Transport Strategy, in collaboration with the South Australia, Western Australia, Queensland and Commonwealth governments. The Strategy will propose specific actions to address issues faced in remote and regional areas in relation to transport infrastructure, services and regulation. On 22 May 2015, the Council approved the release of the draft Strategy for public consultation. As part of the consultation period, stakeholders are invited to provide feedback on the draft Strategy and its proposed actions. For more information on the Strategy, or to make a submission, please visit the following link: www.transport.nt.gov.au/nrrts. Please note the closing date for submissions is 5pm Friday 31 July 2015 (ACST). Transport – A Vital Role The availability and quality of transport infrastructure and services impacts on every part of our society and wellbeing. Good transport systems provide a platform for improving productivity and driving social and economic growth for all Australians. Remote and Regional Areas – Supporting all of Australia The remote and regional area of Australia covers 85 percent of the Australian land mass, however has only 15 percent of the Australian population. But significantly, this area is responsible for 40 percent of Australia\u27s GDP due to its considerable resource sector and primary industries. Transport Challenges Remote and regional areas face specific transport challenges which do not apply to the highly populated eastern seaboard of Australia – all influenced by vast distances, a small population, climatic extremes, and demanding geography. It is for this reason that a one size fits all approach to transport regulation and infrastructure and service delivery just doesn\u27t work for the remote and regional areas of Australia. The Need for a National Strategy The aim of the National Remote and Regional Transport Strategy is to provide some practical solutions to the issues and challenges faced by transport system providers and users so that this important area of Australia can continue to grow and contribute to Australia\u27s wellbeing. The Council will discuss the final Strategy and its implementation at its meeting in November 2015

Appropriate technology for Aboriginal Enterprise Development

RADG has been developing appropriate health technology for use in remote communities in Australia. The greatest need for these technologies has been in Aboriginal communities. In developing appropriate technical artifacts, RADG has confronted two problems. Firstly we require good contact with remote communities for consultation and feedback. Secondly, part of making artifacts appropriate for under-developed countries or regions, is the need to include employment and self-determination as part of the benefits of a technology

ICTD for Healthcare in Ghana: Two Parallel Case Studies

This paper examines two parallel case studies to promote remote medical consultation in Ghana. These projects, initiated independently by different researchers in different organizations, both deployed ICT solutions in the same medical community in the same year. The Ghana Consultation Network currently has over 125 users running a Web-based application over a delay-tolerant network of servers. OneTouch MedicareLine is currently providing 1700 doctors in Ghana with free mobile phone calls and text messages to other members of the medical community. We present the consequences of (1) the institutional context and identity of the investigators, as well as specific decisions made with respect to (2) partnerships formed, (3) perceptions of technological infrastructure, and (4) high-level design decisions. In concluding, we discuss lessons learned and high-level implications for future ICTD research agendas.Comment: 11 page

Informed consent in refractive surgery: in-person vs telemedicine approach.

Purpose:The aim of this study was to compare the quality of consent process in refractive surgery between patients who had a preoperative consent discussion with the surgeon using a telemedicine approach and those who had a face-to-face discussion. Methods:Patients treated between January and December 2017 (8,184 laser vision correction [LVC] and 3,754 refractive lens exchange [RLE] patients) that attended day 1 and 1-month postoperative visit were retrospectively reviewed. Preoperative consent preparation included a consultation with an optometrist, observation of an educational video, and written information. Patients then selected either a face-to-face appointment with their surgeon (in-clinic group) or a telemedicine appointment (remote group) for their consent discussion, according to their preference. Patient experience questionnaire and clinical data were included in a multivariate model to explore factors associated with consent quality. Results:Prior to surgery, 80.1% of LVC and 47.9% of RLE patients selected remote consent. Of all LVC patients, 97.5% of in-clinic and 98.3% of remote patients responded that they were adequately consented for surgery (P=0.04). Similar percentages in the RLE group were 97.6% for in-clinic and 97.9% for remote patients (P=0.47). In a multivariate model, the major predictor of patient's satisfaction with the consent process was postoperative satisfaction with visual acuity, responsible for 80.4% of variance explained by the model. Other significant contributors were postoperative visual phenomena and dry eyes, difficulty with night driving, close-up and distance vision, postoperative uncorrected distance visual acuity, change in corrected distance visual acuity, and satisfaction with the surgeon's approach. The type of consent (remote or in-clinic) had no impact on patient's perception of consent quality in the regression model. Conclusion:The majority of patients opted for telemedicine-assisted consent. Those who chose it were equally satisfied as those who had a face-to-face meeting with their surgeon. Dissatisfaction with surgical outcome was the major factor affecting patient's perception of consent quality, regardless of the method of their consent

A national study into the rural and remote pharmacist workforce

As for many health professionals, distance presents an enormous challenge to pharmacists working in rural and remote Australia. Previous studies have identified issues relating to the size of the rural and remote pharmacist workforce, and a number of national initiatives have been implemented to promote the recruitment and retention of pharmacists in rural and remote locations. The aim of this study was to explore and describe the current rural and remote pharmacy workforce, and to identify barriers and drivers influencing rural and remote pharmacy practice. A mixed-methods approach was used, which comprised a qualitative national consultation and a quantitative rural and remote pharmacist workforce survey. Semi-structured interviews (n=83) and focus groups (n=15, 143 participants) were conducted throughout Australia in 2009 with stakeholders with an interest in rural and remote pharmacy, practising rural/remote pharmacists and pharmacy educators, and as well as with peak pharmacy organizations, to explore the issues associated with rural/remote practice. Based on the findings of the qualitative work a 45-item survey was developed to further explore the relevance of the issues identified in the qualitative consultation. All registered Australian pharmacists practising in non-urban locations (RRMA 3-7, n=3,300) were identified and invited to participate in the study, with a response rate of 23.4%. The main themes identified from the qualitative consultation were the impact of national increases in the pharmacist workforce on rural/remote practice; the role of the regional pharmacy schools in contributing to the rural/remote workforce; and the perceptions of differences in pharmacist roles in rural/remote practice. The survey indicated that pharmacists practising in rural and remote locations were older than the national average (55.8 years versus 40 years). Differences in their professional role were seen in different pharmacy sectors, with hospital pharmacists spending significantly more time on the delivery of professional services and education and teaching, but less time on medication supply than community pharmacists. Rural/remote pharmacists were generally found to be satisfied with their current role. The main 'satisfiers' reported were task variety, customer appreciation, use of advanced skills, appropriate remuneration, happiness in their work location, sound relationships with other pharmacists, a happy team and relationships with other health professionals. This study described the distribution, roles and factors affecting rural and remote pharmacy practice. While the results presented provide an extensive overview of the rural/remote workforce, a comparable national study comparing rural/remote and urban pharmacists would further contribute to this discussion. Knowledge on why pharmacists chose to work in a particular geographical location, or why pharmacists chose to leave a location would further enrich our knowledge on what drives and sustains the rural/remote pharmacist workforce

Incorporating remote visits into an outpatient clinic

Copyright @ 2009 Operational Research Society Ltd. This is a post-peer-review, pre-copyedit version of an article published in Journal of Simulation. The definitive publisher-authenticated version Eatock and Eldabi (2009), "Incorporating remote visits into an outpatient clinic", Journal of Simulation, 3, 179–188 is available online at the link below.Most telemedicine studies are concerned with either the technological or diagnostic comparisons, rather than assessing the impact on clinic management. This has attributed to the retrospective nature of the studies, with lack of data being the main cause for not using simulation for prospective analysis. This article demonstrates the use of simulation to assess the impact of prospective systems by utilising data generated from clinical trials. The example used here is the introduction of remote consultations into an outpatient's clinic. The article addresses the issues of using secondary data, in terms of the differences between the trial, the model and future reality. The result of running the simulation model show that exchanging the mode of service delivery does not improve patient wait times as expected, and that a protocol change in association with the introduction of remote visits is necessary to provide a substantial reduction in patient wait times

Web Note No. 4a

Replacing Alaska’s public infrastructure would cost nearly $59 billion, in today’s dollars. That includes, as the table shows, the costs of replacing public buildings as well as transportation and utility systems.1 This is an update of an estimate ISER made in 2007—which at that time was the first comprehensive estimate of the cost to replace Alaska’s public infrastructure.2 That 2007 estimate was considerably less—about$39.5 billion—but we emphasized at the time that it was preliminary. It did not take into account that costs to replace infrastructure in remote areas are higher, and it undercounted and undervalued certain types of infrastructure, including power and telephone systems. This revised estimate is based on an analysis of cost differences across the state, additional data on existing infrastructure, and additional consultation with engineers, architects, and cost estimators